Brain Injury Rehabilitation Services

First, I must thank my hon. Friend the Member for North Cornwall (Mr. Tyler), who originally secured this 90-minute slot for a debate, but had to give it up because it clashed with other business in the House that required his presence. There is some justice in his misfortune, for such a clash would not have occurred under the previous sitting arrangements, which he campaigned to change. Next I must thank whoever it was in the Speaker's Office who drew my name to fill the vacated space. That was appreciated not only by me but by the all-party acquired brain injuries group, which I have the honour of chairing.

The group takes the view that more needs to be done to improve brain injury rehabilitation services not only in the interests of the individuals who have suffered brain injuries through accidents at home, at work or at play, in road crashes or owing to medical causes, but in the interests of those who care for them, be they NHS workers, other health providers, the voluntary and charitable sector or families.

I should like to offer my personal appreciation as well as that of the all-party group to each and every person and organisation who individually and collectively seeks to improve matters for brain injury victims. In particular, I mention Headway, the leading UK charity dedicated to providing help, support and services to people affected by brain injury. It also gives much-needed support to families and carers. There are more than 100 Headway groups around the UK. My thanks also go to the United Kingdom Acquired Brain Injury Forum for its valuable contribution, to Rehab UK whose aim is to enhance the social and economic independence of people with disabilities, and to the Brain Injury Rehabilitation Trust, which is a division of the Disabilities Trust.

The seriousness of today's debate stems from the stark fact that every year around 1 million people attend accident and emergency departments with some form of traumatic brain injury. It is estimated that for every 100,000 of the population as many as 15 will receive a serious head injury, up to 20 a moderate head injury and up to 300 a mild head injury. It is estimated that about 120,000 people in the UK live with the long-term effects of a severe traumatic brain injury.

I should declare my personal interest in the general subject of brain injuries. This coming July marks the 25th anniversary of the death of my first daughter. She died as a result of head injuries that she sustained when she fell from wall bars during a gym lesson at school. She was seven years old. Regrettably, despite the efforts of her teacher, who had recently qualified as a first aider, the ambulance personnel and medical teams at Essex County hospital and Oldchurch hospital, Romford, she did not survive. I dread to think what her condition would have been if she had lived. It was my daughter Joanne's tragedy that caused my wife and me to do what we could to help survivors.

We know that medical science has made advances over the past 25 years. More people appear to be surviving as a result of better and earlier diagnosis and the improved treatment that follows. However, that has
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not been matched by advances in rehabilitation—something that the Health Committee set out in its excellent report on the subject in March 2001. It is most regrettable that progress on the Select Committee recommendations has not materialised. I hope that today's debate will contribute towards ensuring that the improvements, which are both necessary and obtainable, can be provided.

I recognise that better rehabilitation services for those with brain injuries will cost money, but greater investment from the outset will cost the public purse less in the long run, which I assume appeals to the Treasury. In addition, of course, it will greatly improve the quality of life of those who have suffered brain injury and their families, who so often have their own lives torn apart by what has happened to their loved one. Perhaps the Minister will give an assurance this afternoon that all the Health Committee's recommendations will be put into action. Those with brain injuries and all who are associated with them would welcome such a declaration.

Headway has told me that the Select Committee's report entitled "Head Injury: Rehabilitation" is a seminal document. Its recommendations define an ideal brain injury service. However, Mr. Graham Nickson, Headway's policy and campaigns manager, told me:
Whilst there were elements in the Government response (Command Paper 5226) which Headway welcomed, overall we were very disappointed at what we felt was a complacent approach.Given that it is nearly two years since the publication of the report, Headway feels that it would be an opportune moment to ask what progress has been made in meeting the standards recommended by the Health Select Committee.
Let us hope that there will be real progress. I know that other hon. Members hope to participate in the debate. No doubt they will discuss some of the Committee's recommendations.

I am grateful to Professor Lindsay McLellan, Professor of Rehabilitation Medicine at Southampton university and chairman of the UK Acquired Brain Injury Forum, for his professional thoughts. He tells me that unless the management structures of the national health service are reformed at the same time as the national service framework is developed, any new resources for meeting NSF standards may be spent in areas other than rehabilitation. The Government already face that issue in respect of the money that they have provided for cancer care services. Professor McLellan suggests that a senior manager in each NHS trust be given responsibility for brain injury rehabilitation services, thus ensuring that the budget is spent correctly and progress is made.

I am sure that the Minister will readily confirm that the NSF will lay down what her Department believes that health and social care services in England need to do for those who have brain injuries. Unfortunately, when it comes to rehabilitation, it is clear that insufficient is being done to honour the spirit and letter of the NSF.

There are no pharmacological treatments for brain injury, which is the poor relation in medical research, even though each year, as I have already pointed out, some 1 million people in this country will seek treatment
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for a head injury. Road crashes are the biggest cause of injury. I am sure that everyone will welcome the moves that are being made across the board to reduce the number of road accidents so that there is less pressure on health services. However, this debate is about people who already have head injuries.

The Health Committee reported:
Head injury is the foremost cause of death and disability in young people. In an age of increased motorisation and violence, head injury is a healthcare problem which is not going to go away. There is a growing population of head-injured people in this country, as improved medical techniques have led to many head-injured people now surviving their accident and living into old age, with a normal life expectancy.
The majority of brain injuries—40 to 50 per cent. of all cases—are sustained by young men aged between the ages of 15 and 29 who are involved in road crashes. Accidents at work and in the home account for 20 to 30 per cent., sports-related injuries 10 to 15 per cent., and violent assaults about 10 per cent. of brain injuries. Men are two to three times more likely to sustain a head injury than women.

Despite the widespread prevalence of brain injury, services to help and support the victims are woefully inadequate. The brain, with its 1 million million nerve cells, can be injured by illness, a physical blow to the head or internal neurological malfunction. Brain injuries can affect young and old, rich and poor, men and women and people from all cultures and ethnic backgrounds.

Greater importance must be attached to rehabilitation. Intensive rehabilitation must immediately follow acute care, which could last several weeks or many months. That should be followed by long-term rehabilitation. Given the importance of rehabilitation following brain injury, have the Government given serious consideration to the Health Committee's recommendation xix, which called for each NHS trust to identify a named manager with responsibility for rehabilitation services?

I would also draw the Minister's attention to recommendation xxi, which states:
We recommend that the Department of Health should help charitable organisations, where they are providing core services, to develop these services further.
I very much regret that the inadequate funding for rehabilitation is likely to get worse if the example of my local branch of Headway is typical. Many Headway groups are struggling financially just to survive, although they are providing a vital service for those with brain injuries and saving the state a fortune. Such groups need more resources, not fewer.

Colchester Headway has been led to believe that the Colchester primary care trust will not be renewing its annual grant. A shortfall of £15,000 in the current financial year has not been paid. It gets even worse for the financial year due to start in April. The ongoing grant, which would be about £56,000, is in doubt.

Colchester Headway says:
Should Colchester PCT decide to withdraw its support from Headway the repercussions will be immediate and very distressing for the people with brain injury and the families from the Colchester area who currently attend the day centre and receive our general support. The knock-on effect of this withdrawal, at a time when the world believes money is pouring into the Health Service, would not only be difficult for the public to understand, but would probably affect the viability of our organisation.33WH
Will the Minister explain why money for rehabilitation for those with head injuries is being reduced? Perhaps my example is purely localised, and more financial support is being provided elsewhere. Either way, intervention by her in this funding crisis would be appreciated. Will the Minister point out to her Treasury colleagues the overall saving that will accrue to the public purse if proper resources are put into rehabilitation? Continuing the theme of joined-up government, I suggest that she involves the Department for Work and Pensions, from which I detect mixed messages.

I congratulate the hon. Gentleman on securing the debate. I hear what he is saying about Headway, which works so well in my locality. However, vocational rehabilitation can also be important to people who are making even greater recoveries from their injuries nowadays.

I thank the hon. Gentleman for that welcome comment, which I fully endorse.

Is the Minister aware of the views of Lord Morris of Manchester, the much-respected former Minister who did so much to help those with disabilities? In November, he attacked cuts in services to disabled people with acquired brain injuries, which are forcing the closure of centres specifically designed to help them. What is her response to that?

Rehab UK estimates that, for an average investment of £15,000, their 48-hour-a-week vocational rehabilitation programme saves the benefits system £300,000 over the lifetime of a person. The Brain Injury Rehabilitation Trust estimates that lifetime savings are in the range of £400,000 to £1 million per person, depending on the severity of the injury and the person's life expectancy. Those are huge savings for relatively little outlay.

The financial benefits are one thing. Of even greater importance is the improvement to quality of life for those with brain injuries and those who care for them.

I congratulate the hon. Member for Colchester (Bob Russell) on securing the debate. I do so with some degree of jealousy, as I have been applying for a debate on this subject whenever my diary has permitted me since October 2001. I did not have an Adjournment debate in the House for the whole of last year. I wanted to initiate a debate not because I have been personally touched by a tragedy such as the one so movingly described by the hon. Gentleman—I am sure that he has our condolences—but because, as is often the case for Members of Parliament, people had come to my surgery in great distress about people who had received severe head injuries that were virtually, but not completely, terminal. They are people with very high dependency.

To give hon. Members the flavour of what I am talking about, I will mention the case of a young girl who was badly injured in a car accident. She was unable to speak, and her mother was in real distress. The young girl was placed in a home that had the duty to look after her. The subject of the debate that I wanted to secure was the role of family and friends in the care of those
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with severe head injuries. I hope that the Minister agrees that it is vital that family and friends are given a much clearer role in the care of such people.

In the case in question, the mother alleged that the home was not treating her daughter in the way that had been intended. Specifically, her mother said that the state was giving the home resources for physiotherapy that were not being applied to her daughter's physiotherapeutic needs. One tremendously important aspect of the debate is that the patients have no voice. They literally cannot talk or sign, and if they are in distress, the only voice that they have is that of those who are either good friends or family—the voices of those who love and cherish them.

The mother asked to see the physiotherapy that was being given, not least because she was more sensitive to her daughter's distress than someone who was new to her daughter's needs and forms of communication. She was denied that access and told effectively that she would be in the way; that the treatment was medical and would be carried out in a way that would not require her presence. The mother put a tissue in the wheelchair behind her daughter's back and one under her arm. Her daughter came back from an hour's "physiotherapy", and the two tissues were still there. That, of course, is an allegation and there may be a problem with a particular home. Indeed, extensive inquiries are being conducted into the home.

However, it is important that we do not focus on one home and say that it failed this young girl and did not respect her mother or family and friends. I submitted an extensive dossier to the Department of Health in October 2001 on that and related cases. In all of them the role of family and friends was marginalised, and patients were denied a voice. For example, if a family visiting a patient in room A went into room B to find out how another patient was doing and ask how their family were coping with the stress and pain of someone they loved being in such a sad state, they were told that they were a source of infection and were not allowed in room B. Fraternising between relatives was discouraged.

I understand that it is extremely difficult for the carers of people in a dreadful state to cope with the distress of the family. Some people do not have families to represent them; the only person who visits them may be someone who serendipitously calls into their room on their way to visit a relative or friend. However, unless there is a regime that integrates into their care those who have love and concern for them, patients' quality of life is even further reduced and family and friends are denied the capacity to endure the pain of the patient's suffering constructively.

This issue arose in the House yesterday and the Under-Secretary of State for Health, the hon. Member for Salford (Ms Blears), spoke eloquently on the matter. People have made representations to her about the over-medicalisation of thinking about people's needs. We must allow those with brain injuries to be given an effective voice, and allow those who take on that role to contribute to their care. It should be absolutely clear that to marginalise that voice and prevent people from receiving visits is a major infringement of human rights.

When it comes to the crunch, looking after those with severe brain injuries is not like "Footballers' Wives"—I have to confess that I have followed that programme
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rather avidly. The football manager in that programme who was in intensive care had someone looking after him all the time. In reality, one does not expect such levels of care to be available. People who have severe brain injuries have problems, such as the fact that they are incontinent of faeces, which makes caring for them extremely difficult. It does not come over on television, but patients can suffer grave indignity in a situation that may generate infection unless there are people around who can act as their eyes and ears and attend properly to them, which is something that family and friends often do. They must be able to say that they believe that someone is in distress, and there must be someone to pay attention to that instead of telling them, "It's not your business. You shouldn't have been there anyway. We're the professionals and we know best."

We must find a way of factoring in a role for family and friends, and extend it so that the family can care for their relative at home if they have visited them in a nursing home for some time and believe that they could be better looked after, loved and more constantly attended to there. It is right that we do everything that we can to extend to those people the Government's current policies on looking after people at home.

Brain injury victims are not just patients. Most of the families have some form of communication with them, and a sense of whether or not they are comfortable, and whether they are at peace or in distress. The expertise of family and friends and their potential for caring are the most important considerations of the debate. It might mean that someone dies when they might otherwise have lived. I do not know, but I would prefer to die having been loved than to live a long time in a state of distress.

Like the hon. Member for Hemel Hempstead (Mr. McWalter), I have long taken an interest in the subject of brain injury. I am a founder member of the all-party group on brain injury; the hon. Member for Colchester (Bob Russell), who secured the debate, is now chairman of that group, on which I congratulate him. I am also co-chairman of the all-party group on disability. Most significantly, I might be alone among those contributing to today's debate in having had the misfortune to suffer a serious head injury, from which, fortunately, I made a good recovery. I will go into the reasons for that later. My interest in the subject is therefore profound and of long standing.

I intend to highlight three of the key issues that we should address in the short time available to us today, and I hope that the Government will take them up. Before I do so, it might be worth emphasising some of the background information without, I hope, replicating what has already been said. I can do no better than to quote from the Health Committee's 2001 report, to which hon. Members have referred. The report states:
Head injury is the foremost cause of death and disability in young people. In an age of increased motorisation and violence, head injury is a healthcare problem which is not going to go away. There is a growing population of head-injured people in this country, as improved medical techniques have led to many head-injured people now surviving their accident and living into old age, with a normal life expectancy.36WH
That observation raises several points, the first of which is that head injury is a significant and growing problem, especially among some sections of the population such as young men, who are more at risk from head injury than any other group.

The second point is that the problem is under-recognised. Head injury is not the most glamorous of issues. Headway does a fine and important job, but it is not a charity that springs to the minds of those who are not interested in the subject when they list the charities that they know best. That may be because the wider population does not find some of the images associated with head injury comfortable. It is not a glamorous or sexy subject for many people until they come up against it because they, a member of their family, or someone they know happens to suffer head injury, and they are forced to deal with the realities associated with it.

The third point made by the Health Committee is that the problem is becoming more serious because of the impact on the need for ongoing rehabilitative provision of people living longer. In the past, a significant proportion of people suffering major head injuries might not have survived the initial trauma, but that is no longer the case and effective treatment at the traumatic stage often confers a normal life expectancy.

It is important to set out the terms of the debate and to clarify for those less familiar with the subject how brain injuries are classified. Brain injuries are usually divided into three categories—mild, moderate or severe—and the ongoing effects of the injury are often a result of the speed at which treatment is provided. If people receive the good-quality medical treatment that they need quickly, leaving them unconscious for a shorter time, they are likely to make a better recovery. If the loss of consciousness and responsiveness continues much longer, it is more likely to result in long-term effects.

What are the effects of head injury? They are many and varied—and can be invisible. Many of the impacts cannot be recognised at first sight. They include short-term memory loss, concentration and sensory problems such as loss of taste and smell, lack of motivation, inappropriate behaviour, dramatic mood swings, changes in personality, emotional instability, problems with comprehension, loss of organisational and planning skills as well as physical problems such as lack of balance and co-ordination. Many of those symptoms would not necessarily be apparent on meeting a head-injured person. They are not always apparent even to carers or colleagues at work—certainly not employers—if head-injured patients return to their old jobs.

Suffering from several conditions but showing no obvious physical sign of injury poses massive difficulties to the person concerned. The invisibility of their disabilities often prevents them from gaining the consideration or treatment that they warrant and deserve.

Yes, the hon. Gentleman is absolutely right and I intend to amplify that point. The family often has to pick up the pieces, and it is vital to ensure that family members are well informed and able to anticipate what they will have to deal with. I am grateful to the hon. Gentleman for his informed and heartfelt contribution to the debate.

Let me summarise three main points. First, the Government must recognise head injury or brain injury—the subject of today's debate, which amounts to the more traumatic effects of head injury resulting from a blow or knock to the head—as a distinct condition. We have already mentioned car accidents and other injuries, and I suffered head injuries as a result of a motor vehicle accident, but, if you will allow me an aside, Mr. Benton, I well remember meeting in hospital a postman who had suffered a similar injury, but with much worse effects, from slipping on the ice and banging his head on the pavement. The risks of head injury are many and varied and the extent of the resulting damage does not necessarily reflect the drama of the incident that caused the injury. I hope that the chap involved in that accident made a good recovery, but the journey for him and his family was long and difficult.

Recognition of brain injury as a distinct condition means applying the appropriate services. In that respect, it is important to highlight an earlier point: the sooner someone is treated appropriately, the better is their chance of recovery. There is a useful comment on precisely that subject in the Health Committee's report, which states:
We recommend that Health Improvement Plans and Community Care Plans have a section for planning services which will include the rehabilitative services needed by those with complex neurological conditions such as head injury. We recommend that the Government makes explicit the level at which responsibility for planning different levels of rehabilitation for head injury should be located…We recommend that the Government spells out clearly what steps it will take to improve the situation in the provision of rehabilitation services for head-injured people, and that it instigates plans for action which will come into place long before 2005.
The report is about making initial treatment speedy and appropriate, while ensuring that it is matched by the rehabilitative treatment that needs to follow—a point that the Select Committee was anxious to emphasise. Recognition of brain injury as a distinct condition is a prerequisite for ensuring that we get all our ducks in a row for both initial treatment and rehabilitation.

My second point concerns the co-ordination of services between different agencies. Addressing brain injury is often a multi-agency task. We have already heard about health services, but many other organisations such as the Department for Work and Pensions, social services, local authorities, the charitable sector, the private sector and a range of other central and local government departments have a role, particularly in the rehabilitative aspects of the problems.

Frankly, the level of communication at the moment ranges from poor to very poor. It is not good enough to say that we are getting there and making the right moves. We need to put in place some dramatic measures on exchanging information and communication between agencies, and we need to be able to give head-injured people and their families a guarantee that there will not be duplication or contradiction in the
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information with which they are provided and the type of treatment that they receive. Up and down the country, the picture is patchy, as I am sure the Minister knows, and those involved with head injuries will confirm that view.

My third point brings me back to the intervention by the hon. Member for Hemel Hempstead. We need to work in a more thorough way on the provision of information, and the understanding and comprehension of the problems associated with head injury. That applies first to the people affected and their carers, which is the hon. Gentleman's point. Those dealing with someone who is head injured face extraordinary challenges, not least possible changes in personality—the head-injured person may become like someone one does not know.

The wife of a head-injured man told me that her husband's memory of their life together had virtually been extinguished, although he could remember his childhood, his family and various other things. In cognitive terms, he could have passed many of the tests that might reasonably have been set for him, but his memory of their life together was almost a blank. Imagine the impact that such memory loss has on any relationship, be it between husband and wife, mother and child, or siblings. Head injury is extraordinarily dramatic for not only the person concerned, but their loved ones. If we are going to give people the support they need to help them to play their part in the recovery of the head injured, we need to let them know the issues with which they may have to deal and to cope. Greater information for carers who are immediately affected is fundamental.

The second challenge is to make information available to the wider public. At the beginning of my contribution, I said that head injury is a forgotten—one might even call it hidden—disability. We have to be much more ambitious in our plans for making the wider public aware of the problem. I know that many of those responsibilities will fall to charities and pressure groups involved in the sector. They do a very good job, and I pay tribute to Headway, which the hon. Member for Colchester mentioned. The organisation does so much good work, not only through Headway Houses in its direct caring role, but through its advocacy role of making people aware of its concerns and advancing its cause. Having said that, Headway needs help. It must work in partnership with Government if head injuries are to become the subject of general knowledge, understanding and concern.

I shall not take much more time, because other hon. Members want to contribute and I know that the Minister wants to reply paying full attention to all the points raised and, no doubt, making many new announcements of what the Government are going to do to address these pressing issues. The hon. Member for Colchester—I almost called him my hon. Friend, but I would never want to apply that description to any Liberal Democrat—mentioned the Government's response to the Health Committee report. His description was very polite, but I will be less so. I think that the Government's response so far ranges from inadequate to pitiful.

I say that not for my own or for party-political purposes, but because it is what most people involved with head injuries say. Most people involved in the
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sector are unhappy with the speed and quality of the Government response. There is room for improvement and I live in hope—although not expectation—that things will improve. It would be less than generous not to expect the Minister, who is diligent and responsible and takes such matters seriously, to listen to today's comments. I hope that she will respond immediately and then in a more considered way, so that we can make progress in this vital field.

Order. Before I call the next speaker, can I remind hon. Members that this debate lasts for only an hour and a half? On such an important subject, I want to ensure that the Opposition spokesman and the Minister have adequate time to reply. I do not want to impose time limits, but I remind hon. Members to keep their remarks as brief as possible. It is important that everybody has the opportunity to speak.

I shall be brief, because I want to ensure that other colleagues have a chance to contribute. I should like to address three issues on which I hope the Minister can give some answers. I come to the debate with an interest in neurology, which I have developed in this House during the past five or six years, and as the vice-chair of the all-party group on disability. I have also been prompted by constituents who suffer from brain injuries.

My first point is on data and the adequacy of the epidemiological research conducted in this country to enable the Department of Health and national health service organisations properly to understand the scale and scope of the challenge. According to the Health Committee's report, the most up-to-date data are more than 10 years old. The Minister who gave evidence to the Committee accepted that there were real difficulties with the figures, with data collection and with the diagnosis of head injuries.

The second recommendation of the Health Committee's report urged the Government to address that serious deficiency in their ability properly to put in place services that match need. Without accurate figures, how can the NHS plan services that meet the real needs of people who have suffered traumatic brain injury and subsequent disability? Back in June 2001, the BMA was prompted to suggest a system of health and injury surveillance in this country and internationally. It said that
the systematic collection, analysis, interpretation and timely dissemination of health care data
would play a vital part in
the planning, implementation and evaluation of public health programmes.
I hope that the Minister can tell us whether such a surveillance system is in Ministers' minds and whether it will become a practical, working reality any time soon.

The second, and related, issue concerns the national service framework, which was announced by the Secretary of State in February 2001. The NSF is meant to address long-term medical conditions. During the Health Committee's deliberations, the then Minister for
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Public Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), said that the NSF may be used
to assess the data currently collected, and to look at what improvements might be made or what research might be needed.
I hope that the Minister can tell us that the early work that is being undertaken in relation to the NSF includes ensuring that the basic evidence base on which services are to be built has been properly established and is robust. There is some question about whether that is currently the case.

Subsequent to the NSF, there was the scoping study in November 2001. I acknowledge that that study, which was published on the internet, identified a need for epidemiological research and a disability needs analysis. That was more than a year ago. Will the Minister tell us whether the work has been commissioned and is in the pipeline?

The NSF is a welcome initiative, but many are concerned about it because, in a way, the current system has successes, saving seven in 10 of those who suffer brain injuries. However, it leaves them in limbo, because it does not adequately provide for their long-term care, support and rehabilitation. We save people's lives, but we do not allow them to go on and live those lives. The NSF faces the challenge of enabling people to live their lives after such a traumatic experience.

In 1996, the social services inspectorate carried out an interesting piece of work that considered the work being done in the national health service. It found that one of the major gaps in service provision was long-term rehabilitation. That remains true. Will the Minister tell us how far the Government have got in implementing the recommendations of the Health Committee and the social services inspectorate on improving services?

The last of my three points relates to specialist commissioning, which is an important part of the overall picture of the provisions of services for people with brain injuries. There are relatively few severely brain-injured people in each primary care trust area, so proper provision of rehabilitation requires co-ordination across several primary care trusts. That raises questions about the arrangements for specialist commissioning. Before Christmas, I tabled several written questions on that subject. I have had one or two answers to those questions, but several still await a reply.

I asked the Secretary of State:
what the process and timetable is for completion of the review into commissioning specialised services;"—
which include neuroscience and neurosurgery—and
how the views of patients will be taken into account, and when he will announce the outcome.
I was told:
A summary of the responses will be placed in the Library in December and guidance will be issued in the new year."—[Official Report, 25 November 2002; Vol. 395, c. 144W.]
I checked with Library staff today and they confirmed that the responses to the consultation have not yet been put in the Library. Will the Minister tell us what the process is, what the timetable is, and when we will get clear announcements about how we intend to safeguard services that will need to be commissioned by a number
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of PCTs in the near future? Several patient organisations are concerned that there is a degree of uncertainty about the commissioning of those services.

I end by congratulating my hon. Friend the Member for Colchester (Bob Russell) on securing this important debate, which is not just about medical care, but about building in the rights, roles and concerns of carers and ensuring that we reflect the needs of patients, who should be treated first and foremost as people.

I shall be as brief as possible. I hope that hon. Members will excuse me if I am not as fluent as I can be, but I shall be chucking out parts of my speech as I go because I realise how important it is that hon. Members want to contribute to the debate.

I congratulate the hon. Member for Colchester (Bob Russell) on securing the debate and I declare an interest in that I am a member of the Select Committee on Health. I was a member of the same Committee in the last Parliament. The Committee produced a report on head injuries that contained 28 well scrutinised and practical recommendations, which would have moved brain injury care and rehabilitation into the 21st century and ensured that the type of NHS services that brain injury sufferers and their families have a right to expect were provided. Sadly, judging by the Department of Health's response to that report and by conversations that I have had with Peter McCabe, who is the chief executive of Headway, the Brain Injury Association, as well as my constituent and friend, it appears that the DOH does not yet give brain injury the focus that it deserves.

The brain is the most precious part of the human body. It consists of highly specialised tissue and is far more complex than the 21st century's supercomputers. Due to that awe-inspiring complexity, even the slightest damage can have extreme consequences. The brain can be damaged in a variety of ways, and depending on the areas damaged and the severity of the damage, it can prove to be anything from relatively harmless to fatal.

As has been said, each year about 1 million people attend hospital as a result of head injury. Having been concussed after a motorbike accident as a teenager and cared for at St. George's hospital in Tooting, I have been one of those people, although I do not wish to overplay my injuries. Many other hon. Members have talked about injuries that members of their family or they themselves have suffered. Some people might say that I have needed my head examining ever since the accident, but I got off lightly. My life could have been different, and I might not have been standing here today. Happily, I am. Sadly, many are not so lucky and are left to pick up whatever pieces they can while coping with severe, ongoing problems.

On average, every year in constituencies such as mine, between 15 and 20 people suffer a severe head injury, 23 to 30 suffer a moderate head injury, and between 375 and 450 sustain a mild injury. Most people recover and return to their normal state or something close to it, but a number of individuals and families have to live with the consequences for a long time.

Brain damage can have various causes, be they genetic, a blow to the head, a blood shortage, a blood clot or cancerous tumours. However, the most common
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reason, which applies in 58 per cent. of cases, is a road traffic accident, as in my case. Other categories include accidents at home and at work, sporting and recreational injuries, and assaults, which include gun crime and domestic violence. There is also the deplorable violence against children, as in shaken baby syndrome.

The more severe the injury, the worse the damage to the brain and the longer it takes to recover, which is why rehabilitation services are vital. Even a minor head injury can leave someone with dizziness, memory problems, poor concentration, tiredness or depression. The vast majority of people recover in a few weeks or months, as I did, but it is important to give people time to recover and not to expect them to cope instantly with demanding situations or to accuse them of malingering.

Thousands of brain injury victims face the difficulty of getting back to work or finding new work. In 1998, it was estimated that 60 per cent. of people with brain injuries had failed to find work after discharge from hospital. It is estimated that nine out of 10 people with brain injuries suffer psychological difficulties. Three quarters have some intellectual impairment, and 44 per cent. have lasting pain and headaches. The cost to the taxpayer is estimated to be £266 million a year, and in cases of severe and lasting difficulty, the cost will mount to many times that in coming years. Emotional and behavioural problems are the most difficult for individuals and their families to cope with.

The Government announced in early 2001 that they would develop a national service framework for long-term medical conditions with a neurological focus, including brain and spinal injury. They later announced, in June 2002, that brain injury would have its own chapter. The NSF is due to be published in 2004 for implementation in 2005. I welcome the Government's intention to set up national standards for long-term conditions such as brain injury. As a Member of Parliament, I am acutely aware of the length of time that it takes to produce NSFs. The recent one on diabetes is a prime example, causing frustration to interest groups and disappointment when it was eventually published.

I am sure that the hope of the groups and individuals who are concerned about brain injury is that, with the NSF in place, there should be an improvement in the quality of services for people surviving a brain injury and in the support offered to their carers. If that is not the case, I hope that the Commission for Health Improvement will enforce the standards set out in the NSF. The net result would be that sufferers and their supporters knew more about the models that the local health and social care providers should follow and the standards that they should achieve. They would have a new reassurance.

I am concerned that the planning process to establish any health or social care services must be based on robust data to ensure that decisions regarding the shape of the service, the likely level of demand, staff training needs, capital investment and all other relevant factors are based on reality, not impression. The epidemiological data that describe the number of people who have sustained a traumatic brain injury, often quoted by the Department of Health, are based on research work carried out in 1991 by McMillan and Greenwood.

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Last October, with Peter McCabe of Headway, I met the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), to discuss the Government's response to the Health Committee inquiry into rehabilitation services following a head injury. I draw the Minister's attention to the Select Committee's second recommendation:
We recommend that the DoH finds ways of improving the methods of data collection on incidence, prevalence and severity of head injury and subsequent disability, as a matter of urgency.
If the Government are still using that data, will the Minister indicate whether they will look favourably on bids for funding for such research?

When considering research proposals, it is necessary to learn the lessons of the Warwick study, which was commissioned by the Department of Health to examine the effectiveness of rehabilitation and used as a basis of good practice to the NHS. When the Department of Health gave evidence to the Health Committee, it accepted that there were problems with the Warwick study and undertook that if another were created, it would be designed differently. That is welcome, as the Warwick study was used as evidence that rehabilitation does not work, and I hope that the Minister agrees that any future research needs to collect data in a systematic way that is consistent and reliable and allows comparison.

I understand that if we are brief and confine our remarks to three minutes, all Members will be able to take part in the debate, so I will rattle through my speech.

I want first to congratulate the hon. Member for Colchester (Bob Russell) on securing the debate. He is a first-class officer of our all-party group on brain injury, and today's debate emphasises that. I want also to pay tribute to the Headway group in Bristol and Mrs. Rita Rees in particular for their pioneering work, which began many years ago and continues still.

I want to draw attention in a slightly different way to an aspect of today's subject: the clear requirement for more research, which has already been partially covered in the remarks of the hon. Member for Sutton and Cheam (Mr. Burstow). The excellent Health Committee report of 2001, which has been much mentioned in the debate. drew attention to that in two of its recommendations. That is not self-praise, as although I am now a member of the Committee, I was not on it when it produced the report, unlike my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh).

The Committee's recommendation ii asked the Department of Health as a matter of urgency to find new ways of improving methods of data collection on the incidence, prevalence and severity of head injury. The Committee wanted that information to be more readily available, mostly in the context of better treatment planning, and that, I think, is what the hon. Member for Sutton and Cheam was emphasising. However, the epidemiology of traumatic head injury is important too, and there is an underlying need for better information to be more readily available.

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It has already been pointed out that much of the information that is currently used is up to 10 years old and based on research done for the Department in 1991. I know that in their response to the Health Committee report the Government have accepted that there are problems with the data, but I am not aware that much has been done to improve the situation, as a few Members have pointed out.

In the context of epidemiology, it is important that brain injury can be easily and robustly identified, particularly following traumatic situations such as car accidents when brain injury may go unnoticed and undiagnosed because of other multiple physical injuries. That can result in patients being placed inappropriately, for example, on orthopaedic wards where staff may have little training in the management of brain injury. I look forward to the Minister telling us whether her Department is, somewhat belatedly, about to put the matter right by commissioning more research in that area.

The Health Committee's other proposal to which I want to draw attention is its recommendation xi, which states:
We recommend that the DoH allocates more of the R&D budget to research into traumatic brain injury rehabilitation".
It was correct then and it remains correct.

I want to make two related points. First, as an ex-medical scientist, I know how difficult it is to interest not only most scientists but research funders, never mind media people, in areas where there will not be major breakthroughs. Everyone likes to be associated with research that is looking for the magic bullet, an anti-cancer drug, a new anti-viral agent or a wonder drug to stop tissue rejection. It is much harder to fund research into the small advances that make life better for people with degenerative diseases and improve the rehabilitation process following trauma.

Secondly, on the importance of steady, small improvements in treatments, I want to urge the National Institute for Clinical Excellence and those who influence its programme of projects to ensure that it carries out more assessments of whole treatments. I am an unashamed admirer of NICE and possibly its best supporter in the House, but I sometimes feel that it is pressurised into spending too much time on new technologies and wonder drugs when it should be looking at more mundane treatments that could bring benefits to many somewhat neglected patients.

I am grateful for having had the chance to contribute to this important debate and look forward to hearing the Minister commit the Government to an adequate level of research in this area, both epidemiological and pathological.

May I use my three minutes to pay tribute to the work of the Royal hospital for neuro-disability in my constituency which, among other things, has set up the first brain injury rehabilitation unit for those in a vegetative state, the first unit for cognitive retraining of brain-injured people with cognitive impairment and the first unit for those with a combination of physical and behavioural disorders? During the past months it has placed great emphasis on research and education in the setting up of the new
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institute of complex neural disability led by Dr. Keith Andrews. He is my mentor and gave evidence to the Health Committee. That institute will enable many brain-injured people, and their families, professionals and carers, to gain access to up-to-date information.

I want to draw the Chamber's attention to the excellent documentary "Coma: Locked In", on BBC2 on 17 December, which followed the treatment of Joanne Douglas from Ayrshire who came down to the Royal hospital for rehabilitation. Joanne's mother, Jeanette Douglas, said after the programme:
Joanne is much better now. I'd really like the programme to give hope to people who find themselves in that situation. It's important to know that there are other people with similar experiences and to know that there is somewhere to go for help. I want other people to know the Royal Hospital for Neuro-disability is there.
During my last minute, I want to make five quick points about the Royal hospital and my knowledge of its work. First, the hospital is not part of the NHS but is a national charity. Any extension of its work, including the units that I described and the institute, must be financed by donations. I was pleased that the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), found time to visit the hospital in September. That was the first visit by a Minister during the 100-odd years the hospital has been open. It is good news that the hospital is now on the NHS radar screen. Many of the specialist hospitals and institutions in that area are independent charities, and we must work out a way forward that enables the co-funding to take place. At the moment, with increased salaries—rightly—being paid to doctors and nurses, many of those hospitals are being squeezed.

Secondly, to pick up on a point made by the hon. Member for Sutton and Cheam (Mr. Burstow), we need to ensure better diagnosis. I draw the Minister's attention to the work being done at the Royal hospital on SMART, which stands for sensory modality assessment and rehabilitation techniques. That has been worked out over a 10-year period using the occupational therapy staff, and has led to patients' potential for recovery and interaction with their environment being greatly enhanced.

Thirdly, other Members have said that the Royal College of Surgeons report clearly shows that funds invested in neurosurgery save on long-term costs. I pay tribute to the investment that is going into the relocation of the Atkinson-Morley hospital, which will be co-located with St. George's hospital in Tooting. I would like to see more neuro-surgical centres.

Fourthly, it is very important, as Dr. Keith Andrews has said, that there should be champions in PCTs and area PCTs. Dr. Andrews is the chair of the neuro-rehabilitation sub-group of the specialist commissioning group that provides a specialist resource to all London PCTs. That group leads the way, and was suggested by the Select Committee report. There should be champions on a regional level, not simply within each PCT, because many of the most serious brain injuries are uncommon.

Fifthly, brain awareness week begins on 11 March. As many hon. Members have said, we welcome the national service framework, but there are many actions that can be taken now that would make a significant difference.
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I hope that the Minister will take those up, and not wait for the national service framework to be fleshed out in detail.

I shall make three quick points. I congratulate the hon. Members for Colchester (Bob Russell) and for North Cornwall (Mr. Tyler), who is currently speaking elsewhere, on securing the debate.

I have been asked to speak by Headway Dorset, which does a fantastic job in my constituency in caring for people with acquired brain injury. I am told that it is unique in receiving NHS funding for rehabilitation. That is working well, and I commend that to the Minister as a practice that could be extended elsewhere.

There is particular interest in the subject in my constituency because of the furore over our search-and-rescue helicopter moving from Portland to Lea-on-Solent, increasing its response time by 30 minutes. The move would increase the problems that may arise from cliff-top accidents and cerebral bends. Someone with cerebral bends was picked up by the helicopter this year, and the case was only dealt with when the helicopter reached the decompression unit at Poole. There is no doubt that in that case, as in many others, an extra 30 minutes would have increased the cost to the NHS considerably.

Finally, has the Department looked at some of the work done in the United States on care pathways for acquired brain injury? People there are examining not only the care pathway, but the whole pathway from incident to rehabilitation. That work is focusing on the fact that if one can decrease the time to treatment, one reduces the effects of the injury and the amount of rehabilitation that is required.

In some cases, paramedics, who in this country have to go straight to accident and emergency, are trained to monitor patients. They have a direct link to neurosurgeons and can make an assessment there and then as to whether it is better to go straight to the neurosurgeon rather than to accident and emergency. In some cases in this country, one may find that a leg is fixed while brain trauma is allowed to continue, making the whole injury much more severe. I would be grateful if the Minister could examine that work and see whether it could be extended to this country. I welcome the recommendations of the Select Committee and look forward to the Minister's response.

I have just one point. When my right hon. Friend the Secretary of State for Work and Pensions announced the pathways to work programme in November last year, I asked him whether the new specialist advisers who would be helping people on incapacity benefit into work would have specialist knowledge and training in the important area of head and brain injuries. He assured me that that would be the case.

If that is to be the case—we certainly hope so—very close working will be required between the Department of Health and the Department for Work and Pensions, as well as between the DWP and the Scottish Executive, who have responsibility for health matters in Scotland. I do not expect the Minister to reply now, but will she
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ensure that, on the pilot schemes, the DWP works as closely with Malcolm Chisholm and the Scottish Ministers as it does with her?

Finally, in my constituency, 39 per cent. of adults of working age, or two in five, are economically inactive. That means that they are neither in work nor looking for work. I urge the Minister to do all that she can to ensure that one of the six pilot schemes is located in Inverclyde.

In common with others, I shall attempt to gabble my way through my speech. I congratulate my hon. Friend the Member for Colchester (Bob Russell) on securing the debate. We offer him our sympathy on the loss of his daughter and our admiration for his determination to initiate the debate.

As many hon. Members have said, head injury is the foremost cause of death and disability in young people. It affects young men disproportionately. My indirect experience was to be present at a road traffic accident in which a young student from the school at which I taught was injured, and had to have rehabilitation afterwards, and at a swimming pool accident, in which someone dived into the shallow end. Obviously, that caused massive trauma for the individual and the family. Many people have made the point that family and carers need a great deal of assistance. I ask the Minister to ensure that they are able to obtain at an early stage the information that they so clearly need.

As I was doing research for the debate, it occurred to me that there are massive links between head injury and other long-term conditions. I understand that a debate tomorrow will consider long-term conditions in the round. There is a great deal of linkage between the effects that all long-term conditions have on carers and families, and the way in which the health service, social care and other agencies work together.

The numbers of people affected have been mentioned, and it has been said that working with figures that are based on projections that are 10 years out of date is not really good enough. Clearly, the Select Committee's recommendations need to be put into practice. However, I make an additional point. The hon. Member for South Holland and The Deepings (Mr. Hayes) said that head injury is not a sexy condition, unlike others such as cancer and heart attack. It is worth bearing it in mind that breast cancer affects about 39,000 people a year, whereas head injury affects 176,000 people a year—four and a half times as many—yet we seem to pay rather less attention to it.

Road traffic accidents account for nearly half of head injuries; accidents at work and at home make up 20 to 30 per cent. of cases; sports-related injuries account for 10 to 15 per cent. and violent assaults 10 per cent. I do not believe that anyone so far has mentioned the part that prevention can play. Clearly, it would be an improvement if we were to prevent the accidents from happening in the first place.

Ninety per cent. of people with head injuries suffer psychological impairment, 75 per cent. suffer intellectual impairment and 44 per cent. suffer pain and headaches. This huge problem has effectively been forgotten by most people, including me. We need better
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data collection. I add my voice to those of the many people who have called for the Select Committee's second recommendation to be implemented.

People who are trying to get back to work or to meet their needs through the disability living allowance should be dealt with by people who are aware of their condition. Disability living allowance staff need training to recognise the problem. As I said in the debate on autism last week, Connexions staff also need to recognise the condition when they are dealing with young people.

Acute rehabilitation services and most community rehabilitation services are run by the NHS. Specialist services for cognitive and behavioural problems tend to be in the private sector, and are too expensive for many people to access. My hon. Friend the Member for Colchester paid tribute to the charities that are working in the area, but charitable groups are struggling.

I have received information from Headway, the Disabilities Trust and Rehab UK. They all make the point that the reorganisation into PCTs and the new health care arrangements mean that the PCTs find other things on which to spend their money, partly because there are too many claims on that money. If we are not careful, that money will not end up where we think it should. Given the numbers that we discussed earlier, it is important that people receive proper rehabilitation.

In the extensive briefing that I received from Headway, for which I am grateful, the point is made that a life worth saving must be a life worth living. I do not know whether Headway is the first to express the point in that way, but it is important. Rehabilitation frees up acute beds, gives people a greater chance of returning to work and reduces the cost of long-term care. As my hon. Friend said, Rehab UK estimates that if a person has access to the 48-week course costing £8,000 to £10,000, there will be a saving of £300,000 per person in disability benefits. We are spending money at the wrong end of the service.

According to Headway, despite the numbers of people concerned, services are woefully inadequate. The growing population of head-injured people presents society with problems that did not exist when medical treatment was not so advanced. Leonard Cheshire estimates that, after acute care in hospital, 70 per cent. of residential placements are inappropriate. As other hon. Members have said, head-injured people need specialist tertiary diagnosis. They need neuro-psychiatric diagnosis and should not be counted as mentally ill although, sadly, some of them become mentally ill as a result of their inability to access the services that they need.

The national service framework has been mentioned. That has been promised for a long time, and the scoping event held on 12 November 2001 was extensive. We expect to see the NSF published in 2004 for implementation in 2005.

I see, Mr. Benton, that I am overrunning my time. I shall conclude by saying that many valuable points have been made in the debate.

This debate may prove to have been something of a landmark in demonstrating an enhanced parliamentary focus on an area of great
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public importance which has not previously received adequate attention. The hon. Member for Colchester (Bob Russell) deserves our thanks for introducing the subject, as do many other contributors who have drawn on their personal experience and commitment in the area. There is an understanding that things are not as good as they should be, and an overwhelming determination to make things work better.

I shall focus on two main themes. The first of those, on what may be termed the professional level, is that the Department needs a greater understanding of what we are facing. Many important figures were given earlier in the debate, and I will add one of my own: every year, half a million children under 16 present at accident and emergency with head injuries, and that is in addition to those suffering from various potentially threatening diseases in the same medical area. It is a huge and growing problem. It is not just a matter of counting heads, but of the Department's ability to identify a condition. As was noted earlier, conditions are sometimes latent or eccentric and may reappear later, with damaging consequences for individuals and their families.

The Department should also reflect carefully on the cost-effectiveness of various treatments. Traditionally, it relied on the Warwick study, but some advisers outside the Department questioned the viability of the calculations and asked whether rehabilitation is worth while. The British Society for Rehabilitation Medicine, for example, took a different view.

American experience should also be taken into account in two main respects. First, strong evidence from American studies shows that early and intense intervention is highly cost-effective and will speed the process of healing and rehabilitation. Secondly, the Americans proved remarkably successful at getting people who have suffered traumatic brain injury back into work. It is not always possible to make people economically active, but it happens much more frequently in America than in this country. Rehab UK published statistics showing that many sufferers in this country are unable to find useful work after rehabilitation.

There is a dynamic pattern to recovery. When people have a serious accident, they may need immediate acute care to save their life. Subsequently, they need further medical care, but the position is dynamic, as new needs—social, economic and educational—develop. We must sort out the different pathways. Recommendation xvi was the most important of all those specified in the excellent Health Committee report.

The present problem is that the path towards a final outcome is strewn with barriers at every turn, and there seems to be a gaping chasm in NHS support for medical care. There is no formal responsibility or duty for vocational rehabilitation and all the follow-through provision from social and employment services. Only rarely do we see good practice; for example, in Aylesbury, where a community rehabilitation team can take people back and forth to the world outside. More typically, the pattern is of unplanned transmission, readmission or emergency therapy after a crisis incident, wasted effort and missed opportunity.

I twice visited an NHS rehabilitation centre at Northwick Park hospital and saw patients having contractures remedied, which is the medical equivalent
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of rework. I also noticed rehabilitation beds lying empty because the funding had been siphoned off elsewhere in the hospital, which suggests that all is not well.

The Minister should note, though without relish, that her colleagues in the Department for Work and Pensions are also at fault. When Rehab UK wrote to me on 22 November, it pointed out that the
lack of support from statutory agencies is creating severe funding problems which are likely to impact the rehabilitation services we are able to offer".
The letter was headed "Urgent Crisis". The Minister for Work replied ahead of his counterpart in health—some consolation. He acknowledged that helping people with brain injuries made good sense not only for the individuals helped, but for the public finances in the longer term. Somewhat chillingly, however, he insisted that it had to be
balanced against other priorities for public spending".
Securing rehabilitation is an expensive process, but it often proves much less expensive than doing nothing or continuing with the present muddled pathways to care.

The Health Committee set the tone two years ago and we now have to wait for the national service framework. We must ensure that it is not characterised by a further wait and inaction, but becomes a genuine long-term framework for change in a sector where we are all committed to securing much better provision than we have at present.

In the six minutes that remain I shall try to reply to as many hon. Members as I can. If I do not get to some points I will follow them up in writing. We have seen the Chamber at its best this afternoon. Hon. Members have brought a range of personal and constituency experience to the debate as well as some specialised knowledge from members of the Health Committee. This is a landmark occasion. It is an opportunity to raise the profile of head injury in the Department and with all our partners.

I congratulate the hon. Member for Colchester (Bob Russell) on securing the debate and on the way in which he presented it, including the extremely personal incident in his life. I should like to reassure all hon. Members that the Department has no intention of being complacent about the Health Committee's recommendations. It carried out an excellent inquiry and made a series of recommendations. All that information is being fed into the external reference group of the national service framework. Those recommendations were very important in developing the Department's work.

The hon. Gentleman and others raised the issue of support for voluntary organisations. There is a section 64 grant for Headway, which will increase its funding over the next three years by £97,000. That is evidence of the Government's commitment to try to support voluntary and charitable organisations. My hon. Friend the Member for Putney (Mr. Colman) made the important point that much of the ground-breaking work has been done in the independent and charitable sector. We have to find better ways for the NHS to incorporate that funding, not simply with grants, but with more deep-rooted partnership working.

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As for joined-up responses by the Government, I can assure hon. Members that the Treasury is indeed on board. It recognises that prevention work in the longer term saves money to the NHS and to the Government. I would draw hon. Members' attention to the job retention and rehabilitation pilots that are being carried out by the Department of Health and the Department for Work and Pensions, funded by a generous £12 million from the Treasury. A further £4.7 million was agreed in August last year. There will be a series of pilots. I note the plea from my hon. Friend the Member for Greenock and Inverclyde (David Cairns) for one of those pilots to be in his area. There will be one in Glasgow, although I know that that is not in his area. It is important that we work closely with the Scottish Executive in developing those issues as they relate to both our nations.

My hon. Friend the Member for Hemel Hempstead (Mr. McWalter) presented a moving case in his constituency and emphasised the central role of users, carers and their families in developing these services. Users and carers are at the heart of the national service framework groups. They know whether the services are working well, what needs to be done and what should be done in a different way. We feed the views of patients and the carers into everything we do in the NHS. It is a key consideration.

I have met people with serious brain injuries in my constituency. It is often difficult for them and their families to adjust to the changes that have occurred. People's characters can change completely after a head injury. They will have different qualities and different ways of approaching situations. That applies just as
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importantly to their employment opportunities. I have met people who did one type of job before their head injury yet after it, although they still have many skills, they do a completely different kind of job.

The hon. Member for South Holland and The Deepings (Mr. Hayes) described a moving personal experience. He is right to say that head injuries have been an under-recognised problem. I hope that the debate will go some way towards increasing awareness. We are developing the NSF for long-term conditions as a whole, but with a particular focus on head injuries and neurological problems, precisely because it is recognised that services have been patchy across the country. The NSF and the NICE guideline should help to address that.

Several hon. Members raised the important issue of data. I am fully seized of that. Our data at the moment depend on accident and emergency departments and various consultants making different classifications. These are complex problems and I will certainly undertake to discuss with my colleague the Minister of State whether we can strengthen the evidence base there.

My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh), in a passionate and practical speech, raised, on the Health Committee report, the importance of ensuring that we have a proper focus on the matter. The hon. Member for Sutton and Cheam (Mr. Burstow) mentioned data, the national service framework, the scoping study and trying to ensure that specialist commissioning is in place. I can reassure him that specialist commissioning will be extended for another year, so that we can ensure that the consortium of PCTs has time to develop, to maximise their special commissioning qualities. We recognise that that is important not only in this field but in others.